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Pittsburgh decimated by 1918 flu pandemic

| Sunday, Nov. 13, 2005

June Earl Austin is still haunted by memories of the world's deadliest influenza pandemic.

A skinny 18-year-old, he was loading freight trains for the Pennsylvania Railroad Co. when the virus swept through Pittsburgh in the fall of 1918.

"There were so many dead people that the undertakers were all full -- they didn't have enough coffins," said Austin, 105, of Oakdale, who lived in Carnegie at the time. "At the railroad stations, they piled the pine boxes with the dead three or four high on the platforms. The whole town was in mourning; there were dead everywhere."

No other big city in the nation had a higher death rate from the 1918 flu than Pittsburgh. More than one in every 100 people -- twice the national mortality rate -- died that year, according the federal Centers for Disease Control and Prevention. During the worst days here, a new person caught the flu every 70 seconds and someone died of it every 10 minutes.

Almost 24,000 people were brought to the city's hospitals and at least 4,500 died, according to data from Pittsburgh Mercy Health System. Mercy Hospital in Pittsburgh treated 1,062 cases of the flu or flu-related illnesses and recorded 275 deaths.

With fears mounting that H5N1 -- a new strain of avian influenza -- could mutate and produce human death tolls three times that of 1918's flu pandemic, experts are urging government officials and public health workers to learn from history.

"There are a lot of lessons, chiefly in what not to do, unfortunately," said John M. Barry, an expert on the 1918 flu pandemic and author of "The Great Influenza: The Epic Story of the Deadliest Plague in History."

"No. 1, the most obvious and maybe the most important, is to take the disease very, very seriously," said Barry, who spoke at a state-sponsored public health conference last month in Pittsburgh about the 1918 pandemic. "No. 2, the government, nationally and locally, needs to tell the truth, which they did not in 1918 and, as a result, society almost disintegrated. Nobody believed anything any authority figure said."

The 1918 flu, referred to as "Spanish Flu" or "the Grip," was produced by a virus that medical officials suspect originated in birds and spread to humans, who had much less immunity to it than the normal flu.

Troop movement during World War I, which ended 87 years ago Friday, enabled the virus to spread rapidly, killing as many as 100 million people.

But newspapers in the United States kept quiet about the emerging pandemic. Two months after the United States entered World War I, on April 6, 1917, Congress passed the Espionage Act, making it illegal to publish opinions considered disloyal or harmful to the war effort.

The headlines in Pittsburgh's eight newspapers during the summer of 1918 blared news about the war, the Pirates' unsuccessful race for the pennant and a heat wave. Influenza -- which infected Europe and Asia and was knocking out entire armies -- only got a bare mention in mid-August when it began killing people on the East Coast.

Little more was written about the flu until Oct. 4, when Pennsylvania's acting health commissioner, B. Franklin Royer, ordered all places of amusement closed to slow the spread after hundreds of people were hospitalized in Philadelphia.

About 1,400 saloons, 164 movie theaters and numerous playhouses in Pittsburgh shut down. College football games were canceled. Schools and churches were encouraged to keep large gatherings to a minimum and to forbid entry to anyone coughing or sneezing.

At the time, there were only 63 confirmed cases in Pittsburgh -- all in military men, according to infectious disease reports. The disease didn't seem to be a public health threat, so a huge outcry erupted against the closings.

But just one day after Royer's order, Charles N. Patterson, 29, of Aspinwall, became the area's first confirmed flu death. Two weeks later, thousands of people showed symptoms -- which included the sudden onset of chills, severe headaches, back pain, fatigue, sore throat and fever.

Living conditions here made people especially vulnerable to the flu, said Jim Higgins, an adjunct instructor at DeSales University in Center Valley, Lehigh County, and a doctoral candidate at Lehigh University in Bethlehem. Workers were packed so tight in boarding houses that mattresses were put in hallways, families lived in damp, unheated cellars and people's lungs already were compromised by smoke from the city's steel mills.

"This gigantic underclass was living in conditions that were banished in other large cities," said Higgins, who has studied the 1918 flu pandemic in Pittsburgh for six years. "It would be like walking into New York City in the 1870s."

Morris Gross, 95, of Oakland, was 8 when the flu hit. The epidemic killed his father's business partner and several neighbors.

"People were dying like flies," Gross said. "They were here one day and gone in two or three. It was bad, it was very bad."

Eleanor "Nellie" Green, 108, of Bethel Park, was sick with the flu for a week when she was 21 and living with her cousin in what is now Jefferson Hills Borough.

"I was so weak," Green said. "I don't know where I got it. It was in the air, and it was pretty hard to tell where you got it because no matter where you went, people had it."

People hurried to bury the dead to keep the flu from spreading.

A mass grave in Winfield Township contains the remains of what are believed to be at least 24 Eastern European miners buried so hastily that some were wrapped in sheets. Coffins were in short supply.

More than 700 children in Western Pennsylvania were orphaned by the flu, according to newspaper reports.

Jo Ripper, 90, of Evans City, Butler County, was only 3 when her mother, Josephine Schiavo, and oldest sister, Mary, went by train to Pittsburgh because the local doctor could no longer care for them.

The Schiavos died soon after arriving at Mercy Hospital. Ripper's father, Antonio, raised her and her six surviving siblings on his own.

"It wasn't easy for my dad," said Ripper, who had also caught the flu. "My sister, Emily, was just a baby."

In 1918, doctors didn't know about viruses. There were no vaccines to boost immunity.

Then, as today, there is no cure for a flu virus -- only symptoms can be treated. Pharmacists ran out of remedies, which ranged from downing a shot of whiskey to gargling with salt and soda water and putting patients' feet in basins of water and mustard powder, something Green's doctor encouraged.

Influenza particularly affected the working population. Almost 65 percent of the cases and 57 percent of the deaths were among people 15 to 40 years old, according to Pittsburgh Health Department statistics released in 1919.

"Fundamental, basic services were operating at a rate less than normal," said Monica Schoch-Spana, a medical anthropologist with University of Pittsburgh Medical Center's Baltimore-based Center for Biosecurity.

Hospitals were so overloaded that they set up tents on their lawns, Barry said. People were asked to volunteer as nurses. Many people stayed home at the first sign of illness to be cared for by family and friends.

Pittsburgh hospitals would be short nearly 8,000 beds if a pandemic were to break out now, according to the University of Pittsburgh Medical Center's avian influenza task force. Hospitals, to improve their efficiency, operate day-to-day with far fewer empty beds than they did in 1918 -- a point driven home each winter.

"Forget pandemic flu, during a regular flu season you have more people coming into the emergency rooms and putting an extra demand on those emergency rooms," said Schoch-Spana. "A lot of ambulances are diverted. The hospitals tell ambulances, 'No, I'm sorry, the emergency room is full, you'll have to go back.'"

Still, there are several key areas where we're better off today than in 1918, Barry said.

People now know that the flu is caused by viruses and that vaccinations produce immunity. Antiviral drugs, such as Tamiflu, can lesson the severity if given within 48 hours of the first symptoms.

Officials can slow the spread of the virus through quarantines, Barry said. The World Health Organization is encouraging the slaughter of hundreds of millions of birds in Asia suspected of carrying the H5N1 virus and closely monitoring known human cases.

Open, honest communication from government and medical officials is critical, Barry said.

"If you start educating the public, they will be prepared to close schools and take other measures," Barry said.

When the next pandemic strikes, one of the most important things people can do is not panic and realize that the illness will pass relatively quickly, Higgins said. Though it came in waves, the worst of the 1918 pandemic held Pittsburgh in its grasp for less than two months.

"In the end it's going to go the way of all epidemics," he said. "It will go away."

Allison M. Heinrichs is a staff writer for the Pittsburgh Tribune-Review.

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